Mental Health Pathways Linking Healthcare Discrimination to Suicidal Ideation Among Sexual Minority Men

Background and Purpose: Suicidal ideation is a public health and social welfare concern, with sexual minority individuals being at elevated risk of suicide. Literature has examined the predictors, risk factors, and mitigators of suicidal ideation among sexual minority men (SMM) using the minority stress model framework. Minority stress theory posits that LGBTQ individuals experience elevated health risks due to ongoing exposure to minority-specific stressors, such as discrimination. In healthcare settings, discrimination may be especially harmful as it may occur through content intended to promote well-being. The Psychological Mediation Framework further suggests these discrimination-related stressors may affect behavioral outcomes through psychological pathways. These frameworks provide a foundation for understanding how healthcare settings influence clients’ psychological processes and in turn may contribute to suicidal ideation among SMM.

The current study addressed three aims. First, the relationship between healthcare discrimination and suicidal ideation was tested. Next, depression was tested as a mental health mediator in the relationship between healthcare discrimination and suicidal ideation. Anxiety was also tested as a mediator in the relationship between healthcare discrimination and suicidal ideation. This approach helps clarify the mental health pathways by which minority stressors, like healthcare discrimination, may predict suicidal ideation among SMM, an area that remains understudied.

Methods: Participants were recruited by geo-location apps. Data were analyzed from a sample of 505 SMM who have a lifetime history of suicide ideation. The study’s survey assessed healthcare discrimination through the Discrimination in Healthcare Settings Scale. Depression and anxiety were measured through the Patient Health Questionnaire for Depression and Anxiety (PHQ–4). Recent suicidal ideation over the past two weeks was assessed by asking participants, “Over the past 2 weeks, have you had thoughts that you would be better off dead or thoughts of hurting yourself in some way?”, a question originally developed for the PHQ-9. Covariates included age, education, race/ethnicity, sexual orientation, and sex assigned at birth.

Results: Among 505 individuals, 30% reported experiencing suicidal thoughts over the past two weeks. The levels of depression (x̄= 2.00, SD = .85) and anxiety scores were below the clinical threshold (x̄= 2.03, SD = .89). Most participants reported low scores of healthcare discrimination (x̄= 2.00, SD =.84). Within this sample, healthcare discrimination was significantly associated with suicidal ideation over the past two weeks (β = 0.11, p = .018). Mediation analyses demonstrated that both depression (β = 0.50, p<.001) and anxiety (β = 0.38, p<.001) partially mediated the relationship between healthcare discrimination and recent suicidal ideation.

Conclusion and Implications: These findings suggest that the mental health pathways of depression and anxiety link healthcare discrimination and recent suicidal ideation. Anxiety was an especially unique finding as it is typically understood that suicidal ideation is a symptom of depression. The results suggest that suicide prevention efforts should be geared toward responding to healthcare discrimination as it pertains to interpersonal contributors of suicidality, as well as addressing the mental health pathways of distress as intrapersonal contributors of suicidality.